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If a child is separating sounds instead of smoothly blending them together, you should stop him/her im mediately. Dictations One should not expect students with dyslexia being able to write dictations with the same speed and accuracy as the others. There will be a lot of missed, unfinished words, and even those that are written down may be with errors. Whenever the student with dyslexia has to write a dicta tion, allocate extra time, allowing the student to check his result to find and correct any mistakes. Fluent reading Please, pay special attention to the automatization of the sight words reading. If necessary spend more time on this exercise until you are sure the child is able to recognise all small words quickly. Advice parents to keep on reading to the child, even if he/she already has some reading skills. In the structured audiobook, the text and the audio are synchronised and the student can use both eyes and ears when reading the text. Explain to the child why it is important to respect the punctuation while reading. You may make a demonstration of the importance of the punctuation marks: at first read a text without re specting the punctuation; then read it again with proper expression. You may dedicate some time during lessons to train ex pressive reading, where the pauses and intonation are very important (role-play could be used). Do not expect that children will be able to use punctua tion correctly when writing dictations. Teach ing the children to add punctuation in dictations can be done step by step: At first, they should be able to put in the capital letters independently (without a reminder). Reading comprehension You may prepare flash cards for the unfamiliar or diffi cult words in the text the children are asked to read. Use some time during the lessons to teach pupils how to find an unfamiliar word in a dictionary; discuss the meaning of the word in the context of a sentence.

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Text-dependent questions that involve analysis, evaluation, and synthesis require students to look carefully and Excerpted from Multisensory Teaching of Basic Language Skills, Fourth Edition by Judith R. To answer text-dependent questions, students must fnd evi dence in the text to support a claim. These questions lead students to understand what a text means, how it works, and what the text implies in terms of a deeper meaning, themes, and other ideas. These include language play, such as saying rhymes; listening to, discussing, and examining books; developing oral vocabulary and verbal reasoning; and learning the purposes of reading, along with gross and fne motor writing activities. Exposure to reading aloud and oral lan guage play fosters development of sounds and symbols and a language about reading. Oral language is the foundation of comprehension and helps the reader use decoding strategies. Phonemic aware ness is the ability to understand the sound structure in spoken words. To learn to read, however, children also must be able to pay attention to the sequence of sounds or phonemes in words and to manipulate these sounds. Children learn to do this by engaging in intensive oral play activities of suffcient duration, such as identifying and making rhymes, counting and working with syllables in words, segmenting initial and fnal phonemes, hearing and blending sounds, analyzing initial and fnal Excerpted from Multisensory Teaching of Basic Language Skills, Fourth Edition by Judith R. Fast and accurate decoding of familiar and unfamiliar words and spelling rest on the alphabetic principle: how the written spellings of words systematically represent the phonemes in the spoken words. It requires explicit, systematic, and sequential instruction for at least 25% of students, without which they are likely to fail. Word accuracy and automaticity are problem areas for most students with reading/learning disabilities. Slow decoders are poor at comprehension due to reduced attentional and memory resources. Adequate oral read ing fuency rates with connected texts leads to better comprehension. There are reading fuency goals for frst through eighth grade supported by research (Hasbrouck & Tindal, 2006). Overall, fuency needs to be addressed in each of the component sub-skills of reading instruction. It has been proven to have a signifcant role in learning word meanings and improving spelling. Exposure to Greek and Latin roots, Anglo-Saxon compounds, and prefxes and suffxes helps students read and spell an unlimited number of words. The predictive value for vocabulary in later reading com prehension and the relationship between kindergarten and frst-grade word knowledge and elementary, middle, and secondary reading per formance have been documented.

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They develop gradually during brain matu ration and have diferent prognoses, diferent predis 1. The se behavior and with positional reactions are included verity of motor involvement difers. The number of children Hemiplegia is a unilateral defcit in mobility most with spastic triplegia has increased with the increased ofen spastic in nature. Etiologically, intraventricular hemiparesis, especially if the episodes were present bleeding with asymmetrical infarction is common. Acquired all four extremities are equally afected have a bilateral hemiparesis of vascular etiology requires a specifc di hemiplegia syndrome. The presence The frst manifestations of spastic diplegia can al of epilepsy is signifcantly linked to mental retarda ready be observed in the early stages of development tion. Hemihypo a pathological postural foundation followed by path genesis is more pronounced on the upper extremity, ological phasic mobility. Next, the fexibility of the knee and elbow moved and in a severe form, no isolated movement of fexors and extensors is being assessed followed by the hand or any other upper extremity segment is pos ankle range of motion, hand, thumb and fnger fex sible. In severe forms, the patterns typical for cess, but also on the physiological state of the nervous a newborn persist. Prenatal factors contribute to Intention Tremor a great extent on the onset of involvement. In the ma this is a tremor observed prior to reaching the target jority of children with a cerebellar syndrome, mental of movement. It is as potonic picture begins to show spasticity in the sec sessed whether the elbows are away from each other, ond half of the frst year of life. Pseudoclonus emerges with the develop narily used, which are ofen associated with dyskine ment of distal spasticity. In an ideal scenario, the children can am nosis together predict the severity of the injury. More severe forms Persistence and an exaggerated response to the Gal achieve verticalization between the ffh and the tenth ant refex are typical signs of dysfunction. Verticalization and bipedal locomo to spastic forms of involvement, the grasp refex of the tion are not achieved in the most severe forms. The suprapubic and crossed extension forms: refexes become absent in the frst trimester. Based on external and some changes in muscle tone resulting in typical changes times also internal stimuli, the infant reacts with a hy in body posture. At rest, the infant is hypotonic and sud athetoses develop from neonatal hypotonia. Hypoto denly as a reaction to external stimuli hypertonia ac nia is mainly axial (trunk) and proximal. During occur with the lower extremities positioned in exten swallowing, tongue support against the upper palate, sion.

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Avoidance of dairy products or the addition of lactase dietary supplements is essential for those with lactose intolerance. The addition of fiber may improve fecal incontinence by functioning as a stool bulking agent to increase volume and density. It is difficult to consume the recommended daily amount from diet alone, and fiber supplements often are required. Although the increased stool volume and density helps many individuals maintain continence, excessive fiber with inadequate fluid intake may predispose elderly patients to fecal impaction. Loperamide (Imodium) and diphenoxylate hydrochloride with atropine (Lomotil) are the most commonly used agents. Loperamide has been shown to prolong transit time and stimulate anal sphincter function. With either of these agents, careful titration is recommended to prevent the primary side effect of constipation. It is generally preferable to begin using 2 to 4 mg of loperamide daily and then titrate up to 4 mg three to four times per day. A 4-mg dose before meals has been shown to increase anal tone and improve continence (93). Lomotil is started at a dose of one to two tablets every day or every other day and titrated up to one to two tablets three to four times a day as needed. Caution should be exercised for patients taking other anticholinergic medications. Anticholinergic side effects include dry mouth, drowsiness, lightheadedness, and tachycardia. It should be used judiciously in those with chronic disorders and in elderly patients because of side effects common to narcotics, including addiction with prolonged usage and central nervous system and respiratory depression. A study of 82 geriatric patients documented the efficacy of pharmacologic treatment for fecal incontinence (94). Those with fecal impaction received lactulose and enemas, whereas those with neurogenic fecal incontinence received codeine phosphate as a constipating agent and enemas. The rate of cure for fecal incontinence was 60% in the treatment group versus 32% for controls (P <. Although increased dietary fiber or fiber supplementation has been shown to improve the constipation-predominant form of this illness, fiber supplementation has little effect on the diarrhea variant associated with fecal incontinence. Tricyclic antidepressants improve abdominal discomfort and are also valuable in diarrhea-predominant patients because of their constipating effect.

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